Proceedings: Primary liver cancer. A review of the clinical features, blood groups, serum enzymes, therapy, and survival of 65 cases.

Abstract

A review of 65 patients with primary liver cancer was made. Of these, 53 had hepatocarcinoma. Primary cancer of the liver was most frequently found in patients aged 50 to 80 years, and was observed in three times as many males as females. There was an increased incidence of hepatocarcinoma in Negroes, especially those with blood group B. The most common symptoms with primary liver cancer were upper abdominal pain, weakness, and weight loss, while the most commonly found signs were hepatomegaly or an abdominal mass. Jaundice and ascites were also commonly found. Serum alkaline phosphatase, SGOT, SGPT, and LDH were elevated in most of these patients. In patients with hepatocarcinoma, 66% had histologically confirmed liver cirrhosis at autopsy. Serial alphafetoprotein tests were performed on 19 patients with hepatoma, in 14 of whom (73.6%) AFP was detectable. No Australia antigen was detected in 12 patients with hepatoma. In this study, 9 out of 16 patients (56%) had subjective and objective tumor responses with continuous 5-FUdR hepatic artery infusion. None of 18 patients treated with systemic cytotoxic agents responded. The difference in response between hepatic artery infusion and systemic therapy is statistically significant (P < .0002). There was a statistically significant lengthening in survival of patients who responded to intra-hepatic artery infusion as compared to non-responders and patients who received systemic chemotherapy. In reviewing the autopsy findings on 30 patients with hepatocarcinoma and 9 with cholangiocarcinoma, there were differences in the incidence of metastases to the lungs or bones between these two types of primary liver cancer.